Lyme Disease Awareness (Read 806 times)

I'm sure the maps in Ireland are not kept up to date - if they were then one might have some confidence in them; my point is that this man became gravely ill because of an unfounded assumption about the presence of lyme-bearing ticks

So then what do you recommend? Should everybody get Lyme tested every time they have any symptom at all, regardless of their location? You know, since Lyme disease tends to onset with fairly nonspecific symptoms? Or should there be more discerning criteria? If so, what are they, and what evidence is there from empiric study to support them?

Not knowing exactly where your relatives live, I would note that Melrose, MA and Indiana both are in/near Lyme endemic areas. In those places, testing is likely to be indicated.

But that does not mean it is indicated as a general rule.

To clarify, I wasn't saying the test is indicated as a general rule, or that it should be. You seemed to be saying they should not get the test if there was reasonable suspicion....which it seems is not exactly what you meant, as you now differentiate between Lyme endemic vs non-endemic areas. This makes more sense to me.

It's also a risk-benefit issue. If there is a reasonable chance it could be Lyme disease, the benefit is great. The risk inherent in a blood draw is low. But there is (small) risk, and there is cost.

The world and system are not perfect. There is not empirical evidence for everything, or we wouldn't be running so many trials still. Where my wife worked ER in Detroit, it was standard practice to send anything and everything that could possibly need a CT in for one. It did not matter much if it was a big long shot that anything was wrong, it was purely a CYA protocol practiced by the physicians (their words not mine!). So patients got a nice healthy dose of radiation, and Medicaid got nice big bills, for reasons really not related much at all to the health of the patient.

And yes, the county my sister caught it in is shaded on the map. I had not seen the map before so thanks for that.

"If you want to be a bad a$s, then do what a bad a$s does. There's your pep talk for today. Go Run." -- Slo_Hand

I don't think we can paint all testing and treatment with the same brush. When I go to the doctor they usually give me tests & measurements. If my temp or blood pressure came up high they might also give me some treatment too. Are these tests any more accurate or reliable than measuring antibodies in my blood?

Yes, my initial response ... "get the test" is usually directed to my neighbor who, like me, lives in the epicenter of Lyme disease. Since Lyme can reoccur, some things I'm curious to know are:

- What is the accuracy rate of Lyme tests, keeping in mind a second confirming test is usually done?

- What is the cost of the blood and lab work for the Lyme antibody test?

- What is the risk of oral antibiotics, if unnecessary?

If the answers are high, low, and low I'm all for it.

I have to imagine the above risks and costs would not have outweighed what my father in law went through with his Lyme disease. Despite living in a black shaded county, he didn't get the test until a follow-up visit when he was presenting bell's palsy.

Sure. But again, when should you test? Every day just because you live in a Lyme epicenter? Based on symptoms, and if so, which ones? In a black-shaded county, you need to be ready to test with a lower threshold than in a white-shaded county.

Anyhow, to answer your questions:

- Tests for Lyme disease are typically antibody tests. Antibody tests take a while to turn positive (there is a lot of nuance here I am glossing over). A positive antibody test MAY mean that your current symptoms are due to Lyme disease. A negative antibody test does not mean you are Lyme disease free. Typically, whether positive or negative, you will need to repeat the tests 1 or 2 times later, over several months, and with treatment.

- Each round of tests probably costs ~$200. More, if you do additional related tests.

- Lyme disease treatment is often given before the tests come back from the lab, and is not risk-free. Worst case, you might have a serious antibiotic reaction and die. Yep, it happens. Probably more often than Lyme-related meningitis, as described up-thread.

Thanks for the answers. Yeah, there's a lot of nuisance and case-by-case discretion that must be thoughtfully addressed between doctor and patient. I doubt most reasonable people, even in this epicenter, are going to want to put forth the effort to see their doctor and be tested daily unless they are presenting symptoms. If they did, I'd guess they might be better served with a mental health referral.

Considering the monthly cost of my healthcare I'm not going to be overly concerned about a basic $200 test if I feel crappy enough to haul myself in to the doctor looking for help. A day of missed work easily costs more than that. The same blood draw probably will also look for other things (mono, etc...) as well.

Three months ago I got 12 stitches and they sent me home with a prescription for antibiotics. I'm glad I didn't die.

Considering the monthly cost of my healthcare I'm not going to be overly concerned about a basic $200 test if I feel crappy enough to haul myself in to the doctor looking for help.

Three months ago I got 12 stitches and they sent me home with a prescription for antibiotics. I'm glad I didn't die.

The last time I had blood drawn for anemia and thyroid testing, 600 smackers.

My 4-yr-old has been on a strong dose of antibiotics because her ped dentist appears to have messed up and she got two of the worst abcesses I have ever seen. What was I thinking risking her life to save her jaw....

Insert sarcasm or course, the point is that while I am not a fan of unnecessary testing, treatment, and expense, it's not very helpful to be overly dramatic about the risks of some things either. What is the empirical data as to the likelihood of dying from the antibiotics used to treat lyme disease, or the risk of incurring injury from a blood draw comparable to what could be experienced from lyme disease? Experientially I know several people who have suffered significant symptoms from lyme disease, but I can't say I have even heard of one person who had a serious problem from having blood drawn. Antibiotics, yes, I know a couple people who would die if given certain ones...but that doesn't mean they don't take other ones when situations require it.

"If you want to be a bad a$s, then do what a bad a$s does. There's your pep talk for today. Go Run." -- Slo_Hand

I am spaniel - Crusher of Treadmills

echris02

posted: 3/28/2012 at 9:40 PM

What about the risk to society from the gratuitous overuse of unnecessary antibiotics? It's not solely the individual patient that should be considered when evaluating the risk:benefit ratio of antibiotics for nonspecific clinical signs.

Don't get me wrong - I'm fine with the use of antibiotics if there is an actual documented infection; it's just the empirical and prophylactic use for viruses, skin wounds and the like that drives me nuts. If you see signs of infection, fine, take antibiotics. If not, congratulations, you've just helped breed some super-bugs that will likely go on to kill someone else...

What about the risk to society from the gratuitous overuse of unnecessary antibiotics? It's not solely the individual patient that should be considered when evaluating the risk:benefit ratio of antibiotics for nonspecific clinical signs.

Don't get me wrong - I'm fine with the use of antibiotics if there is an actual documented infection; it's just the empirical and prophylactic use for viruses, skin wounds and the like that drives me nuts. If you see signs of infection, fine, take antibiotics. If not, congratulations, you've just helped breed some super-bugs that will likely go on to kill someone else...

A reason to use the test, when possible, before treatment.

My wife's current place of practice requires a positive step test before they will prescribe antibiotics. It drives her batty how people will demand drugs, even when presented with evidence that they will do no good. People were conditioned to do this during the 80s and 90s.

Heck, I don't even go in unless I can't shake it in 2 weeks on my own....so I've needed antibiotics, like, twice in the last decade.

"If you want to be a bad a$s, then do what a bad a$s does. There's your pep talk for today. Go Run." -- Slo_Hand